Inspection on 27/10/05 for H.C.S. (Enfield) Ltd (Holtwhites Hill)

This inspection was carried out on 27th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

H.C.S. (Enfield) Ltd (Holtwhites... 28/11/07

H.C.S. (Enfield) Ltd (Holtwhites... 12/01/07

H.C.S. (Enfield) Ltd (Holtwhites... 27/09/04

H.C.S. (Enfield) Ltd (Holtwhites... 09/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 H.C.S. (Enfield) Ltd (Holtwhites Hill) 221 Holtwhites Hill Enfield Middlesex EN2 8BX Lead Inspector Mr Teferi Degeneh Unannounced Inspection 27th October 2005 11:40 H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V253184.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V253184.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V253184.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service H.C.S. (Enfield) Ltd (Holtwhites Hill) Address 221 Holtwhites Hill Enfield Middlesex EN2 8BX 020 8342 0537 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) H.C.S.(Enfield) Ltd Miss Christina Physentzou Care Home 8 Category(ies) of Learning disability (4), Physical disability (4) registration, with number of places H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V253184.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Limited to eight adults of either gender with a learning disability (LD) who may also have a physical disability (PD). 14th June 2005 Date of last inspection Brief Description of the Service: Holtwites Hill is a care home for eight younger adults with a learning disability. Four of these are also registered for younger adults with a physical disability. The service is managed by HCS (Enfield) Ltd. The house is detached and there is a downstairs extension offering fully disabled accessible bedrooms. Two of these rooms have an en suite shower room and there is a separate disabled accessible bathroom. There are a further four bedrooms upstairs. There is a comfortable lounge, a dining area and a conservatory. Upstairs there is a small multi sensory room. The staffing of the home consists of the manager, the team leader and a team of care workers. There are three to four care staff working on a morning and late shifts and the night shift is covered by two waking night staff. All the people who live at the home have a day activitiy provided either at a day centre or at the home. Currently there are no vacancies at the home. H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V253184.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted over a period of 4 hours, beginning at 11:40am and concluding at approximately 3.40pm. Ms Mary Nyamapfene, a care worker, who was in charge of the shift assisted with part of the inspection. The manager was off work but came to the home to help with the final part of the inspection. Four service users were at the home and three were at a day centre. One service user was out to a health appointment. The inspection activity undertaken included a tour of the building, the examination of service users’ files including care records, the examination of health and safety records and the viewing of staff rotas. Two care staff and the people who live at the home and who were present were observed and spoken to. What the service does well: What has improved since the last inspection? What they could do better: Hand-drying facilities must be available in the toilets. The filing cabinet must be repaired to enable access to and inspection of staff files. Evidence of clear CRB checks and two written references must be available for all staff. At least 50 of the care staff should achieve a care qualification equivalent to NVQ Level 2 by 2005. H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V253184.R01.S.doc Version 5.0 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V253184.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V253184.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The admission’s procedure of the home is satisfactory. This ensures that service users choose the home that meets their needs. EVIDENCE: No new service users have been admitted since the last inspection. The service users’ records and discussions with the registered person indicated that most of the service users have lived at the home since it was first opened about ten years ago. It was evident from four service users’ files that assessments have been reviewed and care plans have been updated. The registered person gave a satisfactory description of the procedure of admission. She said new service users would be assessed to determine in advance whether or not the home has facilities to meet their needs and whether or not the home is appropriate for them. The home’s admission procedure states: “All admissions are arranged on a planned basis”. H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V253184.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9 Satisfactory systems of risk assessments are in place to ensure that possible risk areas are identified and appropriate actions are taken to safeguard the health and safety of service users. Service users have benefited from the involvement of their representatives in the regular reviews of their care plans. EVIDENCE: Four service users’ files were examined. It was evident from these files that care plans have been reviewed with the involvement of service users and their representatives. It was confirmed in a discussion with the registered person that key workers also regularly update care plans. The files seen indicated that social workers and families attended annual reviews. Each service user has a risk assessment. Specialist health professionals have completed risk assessment and provided appropriate equipment for service users. During the tour of the premises a care worker demonstrated how a hoist in a bathroom operated. Other facilities and equipment provided in the home include callalarms, radiator guards, and wind chimes. The staff confirmed in formal and informal discussions that they had adequate induction as to how to use equipment provided for some service users. From conversations with the staff and some service users and from observation it was clear that service users are able to exercise their rights to access communal rooms and facilities of the H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V253184.R01.S.doc Version 5.0 Page 10 home. The people who were at the home at the time of the visit looked happy and relaxed. H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V253184.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14, 15, and 17 The social and leisure activities at the home are adequate. Service users are engaged and have benefited from the activities organised within the home and outside the home. There is a good relationship between the home and the families. The people who live at the home are able to have visitors. The quality, quantity and presentation of the meals provided at the home satisfactorily meet the needs of service users. EVIDENCE: On the day of the inspection three service users were out attending a day service and another service user was at a hospital for an appointment. The registered person confirmed that four service users go to a day centre on a full time basis while one service user has a part time placement. The remaining three service users participate in day activities organised for them by the home. An examination of the files showed that the home has developed a programme of activities for each person living at the home. Discussions with the registered person and an assessment of care plans and the home’s diary indicated that relatives visit the service users. A sensory room with various facilities appropriate to the needs of the people who live at the home is H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V253184.R01.S.doc Version 5.0 Page 12 provided and used regularly. The staff were observed communicating with service users in an appropriate manner. Service users looked happy and said they liked living at the home. The staff supported service users who required assistance with eating their meals. The atmosphere in the dining/sitting room was relaxed and service users were observed enjoying their lunch. The lunch provided on the day of the inspection reflected the home’s menu. The registered person stated that key workers consult service users regarding their food preferences. Except one, all care staff employed at the home have completed basic food hygiene training. Records and discussions with the registered person confirmed that service users have been on trips to various places including Buckingham Palace and Alexandria Palace. Service users also regularly go to public houses (Pubs) and to the parks. It was evident from discussions with the registered person that a holiday away from the home has been arranged for service users. H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V253184.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, and 20 There are satisfactory systems in place to ensure that service users receive appropriate health care. The arrangements for providing personal support meet the expectations of service users. The systems for the administration of medication are good with clear arrangements being in place to ensure service users’ medication needs are met. Service users are confident that EVIDENCE: The files and records seen and discussions with the registered person indicated that service users accessed appropriate health care services. For example, it was noted that an optician and a chiropodist regularly visit the home. A psychotherapist and a dentist also see service users. It was mentioned above that one service user was out for their appointment at a hospital. At the last inspection a requirement was made for the registered person to maintain the temperature of the area where medication is kept at 25oC or below. This has been satisfactorily complied with. The medicines and the medication administration record sheets were checked and were in order on the day of the inspection. The staff who administer medication have undergone appropriate training. H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V253184.R01.S.doc Version 5.0 Page 14 It was evident from observations that the service users are happy with the care provided by the staff. One service user said they were satisfied with their care at the home. Through conversations and observation of the staff it was clear that the staff enter bedrooms with permissions after knocking on the doors. H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V253184.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, and 23 Service users are reassured by their knowledge of the home’s complaints procedure. The registered provider has satisfactory policies, procedures and practices, which ensure that service users are protected from abuse EVIDENCE: In a feedback card previously administered and collected from families and relatives, the majority of respondents said they were aware of the home’s complaints procedure and they did not have to make a complaint. The registered person keeps records of all complaints. One complaint has been recorded and is being dealt with by the registered person. A copy of the home’s complaints procedure is kept in service users’ files. The home’s complaints procedure has been written in plain English with pictorial illustrations. The time scale for responding to a complaint and the local office address of the CSCI is included in the procedure. There is a policy and procedure on adult protection. The manager confirmed that four of the care staff have attended training on the protection of vulnerable adults from abuse and that there is a plan for the other members of staff to embark on similar training. The staff spoken to confirmed that they have read the home’s policy and procedures on abuse. A copy of the placing authority’s policy and procedures on abuse has been obtained by the home. The home has followed the local authority’s procedure in dealing with previous allegations with abuse. H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V253184.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, and 30 The location and facilities of the home are good and service users feel that they live in a safe and comfortable environment. The precautions put in place to control infections and prevent communicable diseases are unsatisfactory. This is evidenced by the lack of hand-drying facilities in the toilets. EVIDENCE: The home is situated in a residential area close to Chase Farm Hospital. There are local public houses within walking distance from the home. Each service user has a single bedroom and two of the rooms on the ground floor have en suite facilities. The cleaner’s post is currently vacant but the staff and service users have kept the home clean and tidy with evidence of no offensive odours. Officers have made visits to the home from the local fire safety and environmental health service and their report testified that the home was safe and clean. Visitors spoken to at the previous CSCI inspection stated that they were satisfied with the standard of a service user’s bedroom and communal areas. Appropriate adaptations and facilities have been provided in bedrooms, corridors, toilets and bathrooms. All radiators in the home are been guarded. The washing machine has appropriate programmes including sluicing facilities. Discussions with the manager revealed that a system is in place for the staff to use gloves and plastic bags when taking soiled clothing to the laundry. During H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V253184.R01.S.doc Version 5.0 Page 17 the guided tour or the premises it was noticed that none of the toilet rooms had hand-drying facilities. H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V253184.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, and 35 The staffing arrangements and the training programmes provided for the staff are satisfactory. This ensures that service users are supported by staff team capable of meeting their needs. Even though there are no immediate concerns with regard to the home’s recruitment procedure, it storage of the staff files is not satisfactory. This is shown by the fact that the registered person was unable to open the filing cabinet to facilitate the inspection of the files. EVIDENCE: The registered person was not able to open the filing cabinet where the staff files and incident/accident records were kept. This meant that the staff files and the incident/accident reports were not assessed. However, discussions with the registered person confirmed that no new staff have been employed since the last inspection. It was clear from the previous inspection of the staff files that the staff have CRB clearance and two written references. It was also evident that the staff have attended training programmes such as health and safety, manual handling, infection control, medication, abuse, communication and basic food hygiene. The staff files will be assessed at the next visit. The registered person has a list of training areas for each member of staff to complete during the year. Discussions with the registered person indicated that one member of staff has achieved NVQ level 2 in care. The manager confirmed that five other members of care staff are currently undertaking training to achieve a care qualification equivalent to NVQ level 2. H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V253184.R01.S.doc Version 5.0 Page 19 The home has sixteen care staff and a manager. Currently two posts, that is, a care staff and a domestic staff, are vacant but are being recruited to. The rota showed that there are a minimum of three care staff on shift in the morning and four staff on shift in the afternoon. Two waking night staff cover night shifts. The rota is detailed in describing the duties and activities of staff on shift. H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V253184.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, and 42 The manager of the home is energetic, committed and open minded. Service users have significantly benefited from the manager’s commitment, knowledge and experience. There are transparent systems of consultation enabling service users and relatives to comment on the quality of services. The home’s premises, facilities, adaptations and practices of regular safety checks are adequate. These have ensured the health and safety of service users. EVIDENCE: The registered manager has been managing the home for over two years. She had previously worked as a team leader. The manager has embarked on training to achieve a management qualification at NVQ Level 4. Discussions with the staff and observations of the processes and activities in the home demonstrated that the manager is open and well respected by the staff. A quality assurance system has been implemented and it was evident that service users and relevant visitors have been consulted with regard to their views on the services and facilities. Discussions with the registered person and the assessment of the documents revealed that the registered person has summarized the outcome of feedback received as a result of quality assurance H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V253184.R01.S.doc Version 5.0 Page 21 consultation. It was evident that the registered person has developed action plans and ensured that copies of the summaries and the action plans sent to the stakeholders. Adaptations that suit the needs of the people who live at the home are provided throughout the home. Records showed that the fire alarm and the emergency lights were tested on 19/10/05. It was evident that the fire extinguishers were serviced on 19/9/05 and the portable electrical appliances have been tested. The hoists are serviced every six months and the last time they were serviced was on 16/8/05. The registered person confirmed that clinical waste is collected by a Company (Initial) weekly. An environmental health officer who visited the home on 30/11/04 concluded that the premises were of “very good standards – no urgent issues”. The fire officers are satisfied with the outcome of their recommendations made on 5/10/05. Five incidents and accidents have been recorded since the last inspection. The nature of these incidents/accidents were not been assessed on this occasion due to the malfunctioning of the keys to the filing cabinet where the details of the incidents/accidents were kept. H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V253184.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X 3 X X X 2 LIFESTYLES Standard No Score 11 X 12 3 13 X 14 3 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 3 2 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 H.C.S. (Enfield) Ltd (Holtwhites Hill) Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 X 3 X X 3 X DS0000010576.V253184.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA27 YA34 Regulation 13(3) 17 Sch 2 &4(6)19 Requirement The registered person must provide hand-drying facilities in toilet rooms. The registered person must ensure that the staff files are available for inspection. The registered person must confirm in writing to the CSCI inspector that the home has received two written references and clear CRB certificates for all staff currently working at the home. Timescale for action 15/12/05 21/12/03 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA32 Good Practice Recommendations The registered person should ensure that at least 50 of care staff achieve a care qualification equivalent to NVQ Level 2 by 2005. H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V253184.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V253184.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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